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Selective clipping of giant anterior communicating artery aneurysms remains a reliable therapeutic option

Clinical neurology and neurosurgery, 2023-09, Vol.232, p.107868-107868, Article 107868 [Peer Reviewed Journal]

2023 Elsevier B.V. ;Copyright © 2023 Elsevier B.V. All rights reserved. ;2023. Elsevier B.V. ;Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 0303-8467 ;EISSN: 1872-6968 ;DOI: 10.1016/j.clineuro.2023.107868 ;PMID: 37421931

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  • Title:
    Selective clipping of giant anterior communicating artery aneurysms remains a reliable therapeutic option
  • Author: Aboukais, Rabih ; Karnoub, Mélodie-Anne ; Haettel, Pierre ; Bretzner, Martin ; Bourgeois, Philippe ; Lejeune, Jean-Paul
  • Subjects: Aneurysm ; Aneurysms ; Anterior communicating artery ; Blood clots ; Clipping ; Computed tomography ; Edema ; Frontal gyrus ; Giant aneurysm ; Hematoma ; Hemorrhage ; Hydrocephalus ; Hypertension ; Ischemia ; Life Sciences ; Medical imaging ; Neurology ; Patients ; Pterional approach ; Visual acuity
  • Is Part Of: Clinical neurology and neurosurgery, 2023-09, Vol.232, p.107868-107868, Article 107868
  • Description: Giant anterior communicating artery (AcomA) aneurysm represent a significant surgical challenge. Our study aimed to discuss the therapeutic strategy in patients with a giant AcomA aneurysm treated by selective neck clipping through a pterional approach. Among all operated patients from an intracranial aneurysm between January 2015 and January 2022 (n = 726) in our institution, three patients with a giant AcomA aneurysm treated by neck clipping were included. Early (<7days) outcome was noted. Early postoperative CT scan was performed in all patients to detect any complications. Early DSA was also performed to confirm giant AcomA aneurysm exclusion. The mRS score was recorded 3 months after treatment. The mRS≤ 2 was considered as a good functional outcome. Control DSA was performed one year after treatment. In the three patients, after a large frontopterional approach, a selective exclusion of their giant AcomA aneurysm was obtained after a partial pars orbitalis of the inferior frontal gyrus resection. Ischemic lesion was noted in 1 patient and chronic hydrocephalus in 2 patients with ruptured aneurysm. The mRS score after 3 months was good in 2 patients. Long term complete occlusion of the aneurysm were noted in the three patients. Selective clipping of a giant AcomA aneurysm is a reliable therapeutic option after a careful evaluation of local vascular anatomy. An adequate surgical exposure is frequently obtained through an enlarged pterional approach with an anterior basifrontal lobe resection, especially in an emergency situation and/or in case of high position of anterior communicating artery. •Giant anterior communicating artery aneurysm represent a significant surgical challenge.•A selective exclusion by neck clipping is possible using a large fronto-pterional approach.•A partial pars orbitalis resection is sometimes required to better expose aneurysmal neck, especially in emergency situation.•The functional outcome was good in the 2 of 3 patients of our series.
  • Publisher: Netherlands: Elsevier B.V
  • Language: English;French
  • Identifier: ISSN: 0303-8467
    EISSN: 1872-6968
    DOI: 10.1016/j.clineuro.2023.107868
    PMID: 37421931
  • Source: ProQuest One Psychology
    ProQuest Central
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